Returning Blood Sugar to Normal Went With Less Heart Death and Heart Failure

CATEGORY: METABOLIC & BLOOD SUGAR

People with prediabetes who brought their blood sugar back into the normal range had roughly 60 percent lower risk of dying from heart disease or being hospitalized for heart failure over the next 20 years. A new analysis of two landmark prevention trials found that the protection held for decades.¹ Prediabetes means blood sugar higher than normal but below the diabetes range.

Remission Meant Normal Numbers on the Same Tests

Prediabetes remission is a plain idea. Blood sugar returns to normal and stays there. The confirming tests are ordinary ones, the same blood tests that flag prediabetes in the first place. Participants who got there did it mostly through steady weight loss, more physical activity and better eating. For many of them the changes were modest and sustained rather than sweeping. The two trials behind this analysis were built to test exactly that kind of change, one in the United States and one in China, and both kept following their participants long after the programs themselves finished. The goal for prediabetes has long been to slow the slide toward diabetes. This analysis points the other way. The slide can run backward, and the heart appears to gain when it does.

1.74 Events per 1,000 Person-Years Against 4.17

In the U.S. trial, cardiovascular death or hospitalization for heart failure occurred at 1.74 per 1,000 person-years among those who reached remission, against 4.17 among those who did not.¹ That is the roughly 60 percent gap, measured across 20 years of follow-up. A parallel Chinese trial tracked its participants for 30 years and landed on a similar benefit. Pooled, reaching remission at any point cut the risk by more than half.¹ Long-running high blood sugar wears on blood vessels and strains the heart. When that injury eases, the gain persists. Researchers call it a legacy effect.

Which Test Flagged the Prediabetes Seemed to Matter

A long study of British civil servants complicates that. People whose prediabetes had been caught by a two-hour glucose test and who then returned to normal had about half the rate of cardiovascular events and death. That test reads blood sugar after a sugary drink. People flagged instead by fasting blood sugar or by HbA1c, a marker of average blood sugar over recent months, showed no such difference.² How far the benefit travels may depend on how the prediabetes was found.

Key Takeaways

• Returning blood sugar to normal tracked with roughly 60% lower risk of cardiovascular death or heart-failure hospitalization over 20 years in the U.S. trial, with a similar benefit over 30 years in the Chinese one.
• Remission came mainly through steady weight loss, more activity and dietary change, and modest sustained changes were enough for many participants.
• A separate cohort saw the heart benefit only among people whose prediabetes had been identified by the two-hour glucose test.

References

1. Vazquez Arreola E, Gong Q, Hanson RL, et al. Prediabetes remission and cardiovascular morbidity and mortality: post-hoc analyses from the Diabetes Prevention Program Outcome study and the DaQing Diabetes Prevention Outcome study. Lancet Diabetes Endocrinol. 2026 Feb;14(2):137-148. link
2. Vistisen D, Kivimäki M, Perreault L, et al. Reversion from prediabetes to normoglycaemia and risk of cardiovascular disease and mortality: the Whitehall II cohort study. Diabetologia. 2019;62(8):1385–1390. link.